The discomfort of patient power

Medical authorities will have to learn to live with “irrational” decisions by the public

Richard Smith, editor

BMJ

Patients will often chose to ignore their doctors' advice and do something that their doctors regard as odd, even crazy. The BMJ described the case of a young man who lost blood after a road crash, declined a blood transfusion, and died in front of disbelieving and disturbed doctors. He was a Jehovah's Witness, and nobody disputed his right to do as he did.1 This is the reality of patient autonomy and power. But does it extend beyond individuals? Does patient power mean that large groups of patients should have the right to behave in a way that “the authorities” think misguided? We see more and more examples where groups of patients chose to ignore the advice of authorities, and it seems likely that this will happen increasingly.

The most prominent example in Britain at the moment concerns MMR (measles, mumps, and rubella) vaccine.2 The authorities, including the BMJ,3 are unanimous in seeing it as a highly effective vaccine with minor side effects. Following a report in the Lancet,4 …